If you’re one of the more than 86 million Americans who suffer from some degree of chronic pain, you should know there is help available.  At St. Luke’s, the staff of the Orthopedic Department includes a pain management physician, Claudio Palma, MD. 

“Managing chronic pain requires a complete review of the cause of the patient’s pain and ongoing care to ease it,” he notes.  “At St. Luke’s, I work closely with our orthopedic and spine surgeons, as well as with our physiatrists who are trained in rehabilitation and the non-surgical treatment of conditions that impact the muscular and skeletal systems. By combining our areas of expertise, we can view each patient’s case from many perspectives.  We have regular weekly meetings to discuss difficult cases, involving other specialists such as chiropractors and physical therapists in the discussions, too.  It’s a powerful way to help patients successfully manage their pain. ”

Board-certified in anesthesiology, Palma completed his fellowship in pain management at the University of California-Los Angeles (UCLA).  “I decided to pursue the field of pain management because it offered me the opportunity to combine my technical skills in anesthesiology with hands-on patient care.  I find it very rewarding to provide ongoing care for my patients and develop close relationships with them.”

The doctor-patient relationship begins with finding the source of the pain, which can sometimes prove hard to pin down.  “I work with the orthopedic surgeons, providing injections to help diagnose areas of the spine or other parts of the body that may require surgery,” Palma says.  “For example, if a patient has pain in his hip, and an injection in the hip eliminates the pain, we know that the problem is not likely to be located in the spine.”

Palma notes that non-surgical pain management can cover a wide range of treatments, from medications, to injections, to the insertion of implantable devices.  “Pain medications fall across a broad spectrum, from mild pain-reducing and anti-inflammatory medicines to morphine-like products,” he explains.  “In some instances, the patient may benefit from antidepressants or from medications for conditions such as rheumatoid arthritis.  In all cases, I work closely with the patient to ensure the medications are being prescribed and taken properly.”

For patients with unrelenting, stubborn pain, Palma sometimes uses implanted devices.   “These devices fall into two categories, both of which are generally reserved for patients for whom physical therapy, medication or surgery has not helped to correct the pain,” he observes.  “The first is spinal cord stimulation.  We insert electrical wires through the skin into the spine to provide electrical pulses that can help relieve pain in some cases.  We can test the stimulation to see if it works before making the implant more permanent.

“The other option is an implanted pump, which delivers very small doses of medications such as morphine directly to the spinal chord,” he adds.  “The advantage of the implant is that the dosage required is generally 300 times less than is required for medicines taken by mouth.  The downside is that the pump needs to be refilled periodically.  The device also can be tested temporarily before making the implant more permanent.”

The majority of Palma’s patients are referred by their primary care physician or an orthopedic surgeon.  Patients may, however, consult him directly.  For more information, or to schedule a consultation, please call the Orthopedics Department at (415) 642-0707.